In the early stages, shingles can produce an extensive range of signs and symptoms. These vary from very mild skin irritation and pain to fever and other symptoms of severe illness.

Until a person develops additional shingles symptoms, they may not realize that this condition is causing their early symptoms.

The varicella-zoster virus, which causes chickenpox, also causes shingles. The virus lives in every person who has ever had chickenpox. If the virus reactivates, it causes shingles. Shingles usually presents as a painful, burning rash that tends to affect an area on just one side of the body.

Keep reading to learn more about the early signs, symptoms, and stages of shingles.

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Shingles outbreaks usually last 3 to 5 weeks. In the first few days, a person may not have a rash. Instead, early symptoms may include:

  • burning or pain on one side of the body, usually in a small area rather than all over
  • unusual sensations, such as numbness and tingling, or shooting pains, on a specific area of the skin on one side of the body
  • feeling generally unwell or having less energy than usual
  • headaches
  • fever
  • chills
  • stomach problems, such as nausea, diarrhea, or vomiting

People who experience these symptoms and have a history of chickenpox should consider that shingles may be the cause. If a person has several risk factors for shingles, it is even more likely to be the culprit.

For most people, a rash appears 1 to 5 days after skin burning and tingling begin. A few days later, the rash turns into small fluid-filled blisters. About 7 to 10 days after the blisters form, the fluid inside dries and causes crusty blisters. The scabs will typically clear up within a couple of weeks.

It is common to have shingles symptoms without a rash for several days. Although less common, some people develop zoster sine herpete, with painful skin symptoms but no rash covering the affected skin area.

Anyone at risk of shingles and experiencing some of the symptoms should see a doctor as soon as possible. Although there is no cure for shingles, early treatment can reduce the outbreak’s severity.

Internal shingles

In people with internal shingles, the condition affects systemic areas of the body, aside from the skin, such as internal organs. Internal shingles is more common in people who are older or very unwell, and it comes with an increase in the risk of long-term complications, such as chronic pain.

The pain may be more intense with internal shingles, and some people develop symptoms in multiple locations on the body.

A person should not assume that they do not have shingles just because they do not have a rash.

Once a person has had chickenpox, even after the chickenpox rash clears up, the herpes zoster virus continues to live in the body. It will not cause chickenpox again. However, if something reactivates the virus, it causes shingles.

While anyone can get shingles, certain factors increase the risk. These factors include:

  • Age: The risk of shingles and shingles-related complications increases with age.
  • A weakened immune system: People living with HIV, AIDS, diabetes, or cancer and those taking medications that suppress the immune system develop shingles more often than other people.
  • Chronic illnesses: Certain chronic illnesses — such as type 1 diabetes, systemic lupus erythematosus, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease — elevate the risk of shingles, especially in younger people.
  • A history of shingles: People with a prior history of shingles are more likely to have an outbreak. A family history of shingles also increases the risk.
  • Stress: People facing intense emotional stress may be more vulnerable to shingles, perhaps because stress weakens the immune system. Sleep deprivation is also a risk factor.

Shingles is very common. About 1 in 3 people living in the United States will have at least one outbreak during their lifetime.

A person should see a doctor if they are experiencing any early symptoms of shingles, especially if they have a history of shingles or are at a higher risk of developing an acute outbreak. The earlier treatment begins, the lower the risk of complications.

A person undergoing treatment for shingles should follow up with a doctor if:

  • the symptoms get significantly worse after treatment
  • the symptoms do not go away within a few weeks
  • new or different symptoms appear in addition to the rash
  • there are signs of secondary infection, such as high fever, an open wound, or streaks coming out of a shingles lesion

People should also speak to a doctor if they have lasting nerve pain in the affected region after the rash of shingles disappears. This complication, called postherpetic neuralgia, affects 10 to 18% of people who get shingles.

A doctor can usually diagnose shingles by evaluating the person’s medical history and symptoms and carrying out a physical examination. However, shingles can sometimes resemble another rash, such as:

A doctor may take a swab from a lesion and send it to the lab for testing. They may recommend blood work or additional tests if they suspect another infection.

There is no cure for the shingles virus. As it is a virus, it will not respond to antibiotics, so it is important to avoid self-medication with old prescriptions.

Often, a doctor will prescribe an antiviral medication, such as famciclovir, valacyclovir, or acyclovir. Pain-relieving medicine can also help ease symptoms. Calamine lotion, colloidal oatmeal compresses and baths, and cold compresses may ease the itching of shingles.

Prevention is also possible through vaccination. People over 50 and those with weakened immune systems are at the most risk of shingles, so they should receive vaccination when appropriate. The shingles vaccine is administered in two doses and can prevent the onset and recurrence of shingles, as well as reducing the risk of complications should an infection take place.

Shingles can be very painful and even debilitating.

Early symptoms can vary greatly, so if a person suspects their symptoms may be due to shingles, they should see a doctor.

The absence of a rash does not mean that a person does not have shingles. It is possible to have pain over the skin without a rash or for the rash to appear later on.

In most people, especially those who are younger or healthy, the symptoms will go away with or without treatment within a few weeks.

However, because shingles can cause lasting pain, it is important to seek prompt treatment even if previous shingles outbreaks have not been severe.